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How You Can Help
Contact us

YMCA Financial Stability Fund

Please Fill Out The Form Below:

Full Name*
First Name Middle Name Last Name Suffix
Date of Birth*
MM
DD
YYYY
Please upload a copy of your Photo ID.*
Address*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Email Address*
Preferred Method of Contact*
- Phone
- Email
Have you completed a minimum 12 months of consecutive service working an average at least one shift per pay period for the YMCA of the Suncoast?*
- Yes
- No
Are you currently in good standing with your employer?*
- Yes
- No
(Personnel file may be reviewed as a part of consideration.)
Have all other financial resources been exhausted including unemployment benefits, stimulus dollars and employer loans?*
- Yes
- No
Have you been awarded any funds from this program previously?*
- Yes
- No
How much have you been previously awarded?*
Enter USD
Did this qualifying event occur in the last 180 days?*
- Yes
- No
What type of assistance are you requesting?*
Please explain the circumstance surrounding your request for assistance.
What amount of assistance are you requesting?*
What financial alternative resources (family, retirement fund, banks) have you exhausted?*
Please list a minimum of three.
How many people are in your household?*
Are you or members of your household currently receiving assistance from a government or another not-for-profit program?*
- Yes
- No
(WIC, Food Stamps, Rent Assistance)
What type of assistance are you receiving?*
Do you have an extended history of relying on the government or charitable organizations to pay monthly expenses with no improvement?*
- Yes
- No
Total Monthly Household Income*
Include child support.
What actions are you willing to take to become financially stable?*
Have you received financial planning or credit counseling?*
- Yes
- No
Have you or anyone in your household been arrested for a crime?*
- Yes
- No
What is the nature of the crime and the subsequent rehabilitation?*
Application Statement: I have read and fully understand the questions asked in this application. I certify that all of the answers I have given are true, accurate, and complete. I unerstand that the omission and/or misrepresentation of any fact from or on this questionnaire will result in immediate rejection of my application. Unless I noted otherwise, I authorize Hands Across the Bay to contact all of my personal references and do a criminal background check. If assisted, I agree to abide by all rules and regulations of Hands Across the Bay. I understand and agree that nothing in this application shall constitute an offer, a contract, or a guarantee of assistance. I understand that any decision is contingent upon my successful completion of all of the Company's lawful pre-assistance checks, which may include a background check. I agree to execute any consent forms necessary for the Company to conduct its lawful pre-assistance checks. By signing below, I agree to all of the terms stated here.
Signature*
Date of Application*
MM
DD
YYYY
Consent
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